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Ishizuka T, Nagata W, Nakagawa K, Takahashi S. Brain inflammaging in the pathogenesis of late-life depression. Hum Cell 2024; 38:7. [PMID: 39460876 DOI: 10.1007/s13577-024-01132-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 10/04/2024] [Indexed: 10/28/2024]
Abstract
Late-life depression (LLD) is a prevalent mental disorder among older adults. Previous studies revealed that many pathologic factors are associated with the onset and development of LLD. However, the precise mechanisms that cause LLD remain elusive. Aging induces chronic inflammatory changes mediated by alterations of immune responses. The chronic systemic inflammation termed "inflammaging" is linked to the etiology of aging-related disorders. Aged microglia induce senescence-associated secretory phenotype (SASP) and transition to M1-phenotype, cause neuroinflammation, and diminish neuroprotective effects. In addition, there is an age-dependent loss of blood-brain barrier (BBB) integrity. As the BBB breakdown can lead to invasion of immune cells into brain parenchyma, peripheral immunosenescence may cause microglial activation and neuroinflammation. Therefore, it is suggested that these mechanisms related to brain inflammaging may be involved in the pathogenesis of LLD. In this review, we described the role of brain inflammaging in LLD. Pharmacologic approaches to prevent brain inflammaging appears to be a promising strategy for treating LLD.
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Affiliation(s)
- Toshiaki Ishizuka
- Department of Pharmacology, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan.
| | - Wataru Nagata
- Department of Pharmacology, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Keiichi Nakagawa
- Department of Pharmacology, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Sayaka Takahashi
- Department of Pharmacology, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
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2
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Huang X, Yuan Sun MM, Zhang XY. Prevalence and clinical correlates of abnormal lipid metabolism in older Chinese patients with first-episode drug-naïve major depressive disorder. BMC Psychiatry 2024; 24:534. [PMID: 39054520 PMCID: PMC11270971 DOI: 10.1186/s12888-024-05967-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 07/15/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Older major depressive disorder (MDD) patients have more complex clinical symptoms and higher abnormal lipid metabolism (ALM) rates. This study aimed to compare clinical differences between those with and without ALM in a sample of older first-episode drug naïve (FEDN) patients. METHODS We recruited 266 older MDD patients. Socio-demographic variables, clinical data, and lipid parameters were obtained. The Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), and the positive subscale of the Positive and Negative Syndrome Scale (PANSS-P) were conducted to evaluate patients' depression, anxiety and psychotic symptoms, respectively. RESULTS In this study, we found that the prevalence of comorbid ALM was 86.1% in older MDD patients. Compared with the non-abnormal lipid metabolism (NALM) group, the ALM group had a higher duration of illness, higher clinical global impression of severity scale (CGI-S) and HAMD scores, higher thyroid stimulating hormone (TSH) and glucose levels. Logistic regression analysis indicated that duration of illness (OR = 1.11, P = 0.023, 95%CI = 1.015-1.216) and CGI-S score (OR = 2.28, P = 0.014, 95%CI = 1.18-4.39) were associated with ALM in older MDD patients. CONCLUSION The importance of regular lipid assessment in older MDD patients needs to be taken into account.
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Affiliation(s)
- Xiao Huang
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Workers' Stadium South Road, Chaoyang Distinct, Beijing, 100020, China
| | - M M Yuan Sun
- Department of Pharmacy, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing, China
| | - Xiang-Yang Zhang
- Hefei Fourth People's Hospital; Anhui Mental Health Center, 316 Huangshan Road, Hefei, 230022, China.
- Affiliated Mental Health Center, Anhui Medical University, Hefei, China.
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Peng P, Wang Q, Zhou Y, Hao Y, Chen S, Wu Q, Li M, Wang Y, Yang Q, Wang X, Liu Y, Ma Y, He L, Xu H, Li Z, Lang X, Liu T, Zhang X. Association of subclinical hypothyroidism with metabolic syndrome and its components among outpatients with first-episode drug-naïve major depressive disorder: a large-scale cross-sectional study. Eur Arch Psychiatry Clin Neurosci 2024; 274:573-582. [PMID: 36961565 DOI: 10.1007/s00406-023-01588-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/06/2023] [Indexed: 03/25/2023]
Abstract
Both metabolic syndrome (MetS) and subclinical hypothyroidism (SCH) are prevalent in major depressive disorder (MDD) patients. However, their relationship in this population remains unknown. The study assessed the association between SCH and MetS in 1706 first-episode drug-naïve (FEDN) MDD patients. We also compared the relationship between MetS and clinical symptoms in patients with and without comorbid SCH. The Positive and Negative Syndrome Scale positive subscale, the Hamilton Anxiety Rating Scale, and the Hamilton Depression Rating Scale were used to detect clinical symptoms. Serum levels of free triiodothyronine, free thyroxine, thyroid stimulating hormone (TSH), anti-thyroglobulin, thyroid peroxidases antibody, cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and fasting glucose were measured. The Area Under the Curve (AUC) was used to test the performance of serum TSH in identifying MetS patients. The prevalence of MetS and SCH was 34.5% (n = 585) and 61% (n = 1034), respectively. The presence of SCH increased the risk of MetS, hyperglycemia, hypertension, obesity, and low HDL-C by 4.91, 3.51, 3.54, 2.02, and 2.34 times, respectively. Serum TSH had a nice ability to distinguish MetS patients from non-MetS patients (AUC value = 0.77). MetS and its components exhibited a positive association with clinical profiles only in SCH patients, but not in non-SCH patients. Taken together, our study suggested SCH was closely related to MetS and might play a vital role in the relationship between MetS and clinical symptoms. Regular thyroid function checks might help early detect MetS.
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Affiliation(s)
- Pu Peng
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qianjin Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yanan Zhou
- Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, China
| | - Yuzhu Hao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Shubao Chen
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qiuxia Wu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Manyun Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yunfei Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qian Yang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xin Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yueheng Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yuejiao Ma
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Li He
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Huixue Xu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zejun Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - XiaoE Lang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Tieqiao Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Zhou LN, Ma XC, Wang W. Incidence and risk factors of depression in patients with metabolic syndrome. World J Psychiatry 2024; 14:245-254. [PMID: 38464768 PMCID: PMC10921290 DOI: 10.5498/wjp.v14.i2.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/14/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Many studies have explored the relationship between depression and metabolic syndrome (MetS), especially in older people. China has entered an aging society. However, there are still few studies on the elderly in Chinese communities. AIM To investigate the incidence and risk factors of depression in MetS patients in mainland China and to construct a predictive model. METHODS Data from four waves of the China Health and Retirement Longitudinal Study were selected, and middle-aged and elderly patients with MetS (n = 2533) were included based on the first wave. According to the center for epidemiological survey-depression scale (CESD), participants with MetS were divided into depression (n = 938) and non-depression groups (n = 1595), and factors related to depression were screened out. Subsequently, the 2-, 4-, and 7-year follow-up data were analyzed, and a prediction model for depression in MetS patients was constructed. RESULTS The prevalence of depression in middle-aged and elderly patients with MetS was 37.02%. The prevalence of depression at the 2-, 4-, and 7-year follow-up was 29.55%, 34.53%, and 38.15%, respectively. The prediction model, constructed using baseline CESD and Physical Self-Maintenance Scale scores, average sleep duration, number of chronic diseases, age, and weight had a good predictive effect on the risk of depression in MetS patients at the 2-year follow-up (area under the curve = 0.775, 95% confidence interval: 0.750-0.800, P < 0.001), with a sensitivity of 68% and a specificity of 74%. CONCLUSION The prevalence of depression in middle-aged and elderly patients with MetS has increased over time. The early identification of and intervention for depressive symptoms requires greater attention in MetS patients.
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Affiliation(s)
- Li-Na Zhou
- Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Xian-Cang Ma
- Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Wei Wang
- Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
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Puchner E, Platzer M, Dalkner N, Schwalsberger K, Lenger M, Fellendorf FT, Unterrainer HF, Schwerdtfeger A, Reininghaus B, Reininghaus EZ. Effects of Metabolic Syndrome and Sex on Stress Coping Strategies in Individuals with Depressive Disorder. Metabolites 2023; 13:metabo13050652. [PMID: 37233693 DOI: 10.3390/metabo13050652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/26/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
Metabolic syndrome (MetS) is related to depression and contributes to reduced life expectancy in individuals with mental disorders. Stress coping strategies are important factors in the development and maintenance of depressive disorders and have been related to metabolic disturbances. The aim of this study was to determine whether there is a difference in the use of positive (re- and devaluation, distraction, and control) and negative stress coping strategies in relation to patients' MetS. A sample of 363 individuals (n female = 204, n male = 159) with a diagnosis of depression was measured with the Stress Coping Style Questionnaire and the Beck Depression Inventory. In addition, we collected data on MetS (waist circumference, triglycerides, high-density lipoprotein, fasting glucose/diabetes, blood pressure/hypertonia) according to the International Diabetes Federation. A 2 × 2 design including Mets (with vs. without) and sex (female vs. male) was performed to test for differences in stress coping strategies. Individuals with depression and MetS scored higher on distraction strategies than depressed individuals without MetS (p < 0.01, corrected with false discovery rate). In addition, we found sex differences in stress coping strategies indicating that women with depression scored higher on distraction strategies (p < 0.001, FDR corrected), as well as negative strategies (p < 0.001, FDR corrected), than men. No significant interaction between MetS and sex was found regarding the higher value of stress coping strategies. Findings suggest that individuals with depression and MetS used distraction strategies to a higher amount to cope with stress, which could be stress eating in some cases, than those without MetS. Women with depressive disorders had higher values than men on other coping strategies in our sample of individuals with depression. A better understanding of MetS and sex-specific differences in stress coping strategies might help to plan more effective preventive strategies and personalized treatment options for depression.
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Affiliation(s)
- Eva Puchner
- Institute of Psychology, University of Graz, 8010 Graz, Austria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria
| | - Karin Schwalsberger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria
| | - Human-Friedrich Unterrainer
- Institute of Psychology, University of Graz, 8010 Graz, Austria
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria
- Institute of Religious Studies, University of Vienna, 1010 Vienna, Austria
- Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, 1110 Vienna, Austria
- Faculty of Psychotherapy Science, Sigmund Freud University, 1020 Vienna, Austria
| | | | - Bernd Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria
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Huang W, Wang Z, Zou C, Liu Y, Pan Y, Lu J, Zhou K, Jiao F, Zhong S, Jiang G. Effects of metabolic factors in mediating the relationship between Type 2 diabetes and depression in East Asian populations: A two-step, two-sample Mendelian randomization study. J Affect Disord 2023; 335:120-128. [PMID: 37150218 DOI: 10.1016/j.jad.2023.04.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 04/13/2023] [Accepted: 04/29/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Observational studies suggested a close link between type 2 diabetes (T2D), metabolic factors and depression, while the causal relationships remained poorly understood. OBJECTIVE To determine the causality between T2D and depression, and to investigate the roles of metabolic factors in mediating the relationship between T2D and depression in East Asians. METHODS Using summary statistics from the largest and most up-to-date genome-wide association studies of depression (12,588 cases and 85,914 controls) and T2D (36,614 cases and 155,150 controls) among East Asians, two-step and two-sample MR analyses were performed to estimate the causal mediation effects of metabolic factors including lipids profiles, blood pressure (BP) and fasting insulin (FI) on the relationship between T2D and depression. RESULTS Genetically predicted T2D was significantly associated with depression (OR [95 % CI]:1.06 [1.01, 1.11], P = 0.043), but not vice versa. T2D was causally associated with lower levels of HDL-C and higher levels of LDL-C, triglycerides (TG), BP and FI. Furthermore, the causal effects of T2D on depression were significantly mediated by LDL-C (β [95 % CI]: -0.003 [-0.005, -0.001], P = 0.007), and suggestively mediated by TG (0.001 [0.001, 0.003], P = 0.049) and FI (0.006 [0.001, 0.012], P = 0.049). LIMITATIONS First, depression was defined by several methods, like symptom questionnaires or self-completed surveys. Second, two-sample MR approach is unable to detect the non-linear causal relationships. Third, independent data sets were not available for replication of our findings. CONCLUSION T2D was causally associated with the risk of depression, and LDL-C, TG, and FI were potential causal mediators of the effect of T2D on depression. Understanding the causality among T2D, metabolic factors and depression is crucial for identifying potential targets for early intervention.
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Affiliation(s)
- Wenyu Huang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Zhenqian Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Chenfeng Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Yang Liu
- College of Life Sciences, the University of Chinese Academy of Sciences, Beijing, China
| | - Ying Pan
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jiawen Lu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Kaixin Zhou
- Big Data Research Center, Fifth Hospital of Chongqing, Chongqing, China
| | - Feng Jiao
- Guangzhou Centre for Applied Mathematics, Guangzhou University, Guangzhou, China.
| | - Shao Zhong
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Guozhi Jiang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China.
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Lee SH, Shin C, Ko YH, Lee MS, Park MH, Pae CU, Yoon HK, Han C. Plasminogen Activator Inhibitor-1: Potential Inflammatory Marker in Late-life Depression. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2023; 21:147-161. [PMID: 36700321 PMCID: PMC9889913 DOI: 10.9758/cpn.2023.21.1.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 01/27/2023]
Abstract
Objective Although several previous studies have examined the association between late-life depression and blood adipokine levels, a marker of chronic inflammation, no studies have comprehensively considered the effects of metabolic syndrome, which is known to affect blood adipokine levels. This study examined blood adipokine levels in geriatric depression after adjusting for the effects of metabolic syndrome. Methods Participants were selected from the Ansan Geriatric Study (depression group [n = 76] and control group [n = 76]). Blood concentrations of four adipokines (adiponectin, resistin, neutrophil-gelatinase-associated lipocalin [NGAL], and plasminogen activator inhibitor-1 [PAI-1]) were measured using immunoassays. The effects of blood adipokine concentration on the diagnosis of depression were analyzed using multivariate logistic regression to adjust for the effects of metabolic syndrome and potential confounding factors. Results When the effects of metabolic syndrome and potential confounding factors were adjusted, only PAI-1 could explain the diagnosis of depression among all the adipokines. The depression group showed a lower blood PAI-1 level than the control group. Adiponectin, resistin, and NGAL could not explain the diagnosis of depression when the effects of metabolic syndrome and potential confounding factors were adjusted. Conclusion This study suggests the possibility that the blood PAI-1 levels in clinically pathological late-life depression may show contrasting results to those with subclinical depressive symptoms. Additionally, considering that most previous studies have been conducted with pre-geriatric populations, the study suggests the possibility that geriatric depression may show inflammatory changes with patterns that are different from those of depression in the pre-geriatric population.
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Affiliation(s)
- Seung-Hoon Lee
- Department of Psychiatry, Veterans Health Service Medical Center, Seoul, Korea
| | - Cheolmin Shin
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Young-Hoon Ko
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Moon-Soo Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Moon Ho Park
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Chi-Un Pae
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho-Kyoung Yoon
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea
| | - Changsu Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Korea,Address for correspondence: Changsu Han Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea, E-mail: , ORCID: https://orcid.org/0000-0002-4021-8907
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Ferriani LO, Silva DA, Molina MDCB, Mill JG, Brunoni AR, da Fonseca MDJM, Moreno AB, Benseñor IM, de Aguiar OB, Barreto SM, Viana MC. Depression is a risk factor for metabolic syndrome: Results from the ELSA-Brasil cohort study. J Psychiatr Res 2023; 158:56-62. [PMID: 36571912 DOI: 10.1016/j.jpsychires.2022.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Metabolic Syndrome (MetS) and depression comorbidity has been recognized, but its directionality is still uncertain. The aims of this study was to assess the association between depression (diagnosis and severity) and MetS (components, diagnosis and trajectory) in the baseline and over a 4-year follow-up period. MATERIAL AND METHODS Baseline and follow-up data from 13,883 participants of the Brazilian Longitudinal Study of Adult Health were analyzed. The Clinical Interview Schedule Revised assessed depressive episode and its severity. MetS components and diagnosis were assessed according to the National Cholesterol Education Program Adult Treatment Panel III. Participants were grouped according to MetS trajectory as recovered, incident and persistent MetS. Logistic regression analysis was conducted estimating odds ratios (OR) and 95% confidence intervals (95%CI). RESULTS Baseline depression was positively associated with recovered (OR = 1.59, 95%CI 1.18-2.14), incident (OR = 1.45, 95%CI 1.09-1.91) and persistent (OR = 1.70, 95%CI 1.39-2.07) MetS. Baseline depression was also associated with large waist circumference (OR = 1.47, 95%CI 1.23-1.75), high triglycerides (OR = 1.23, 95%CI 1.02-1.49), low high-density lipoprotein cholesterol (OR = 1.30, 95%CI 1.08-1.56), and hyperglycemia (OR = 1.38, 95%CI 1.15-1.66) at follow-up. Having three or more MetS components at follow-up was associated with baseline depression, with a positive dose-response effect (OR = 1.77, 95%CI 1.29-2.43; OR = 1.79, 95%CI 1.26-2.54; OR = 2.27, 95%CI 1.50-3.46, respectively). The magnitude of associations was greater in severe depression, when compared to moderate and mild. DISCUSSION These results support that depression is a risk factor for the development of MetS and highlights the need to follow metabolic and cardiovascular alterations in the presence of depression.
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Affiliation(s)
- Lara Onofre Ferriani
- Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitória, ES, Brazil.
| | - Daniela Alves Silva
- Department of Health Integrated Education, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Maria Del Carmen Bisi Molina
- Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitória, ES, Brazil; Postgraduate Program in Health and Nutrition, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
| | - José Geraldo Mill
- Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitória, ES, Brazil; Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - André Russowsky Brunoni
- Center for Clinical and Epidemiological Research, University of São Paulo, São Paulo, SP, Brazil
| | - Maria de Jesus Mendes da Fonseca
- Department of Epidemiology and Quantitative Methods in Health, Nacional School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Arlinda B Moreno
- Department of Epidemiology and Quantitative Methods in Health, Nacional School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Isabela M Benseñor
- Center for Clinical and Epidemiological Research, University of São Paulo, São Paulo, SP, Brazil
| | | | - Sandhi Maria Barreto
- Medical School & Clinical Hospital, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maria Carmen Viana
- Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitória, ES, Brazil; Departament of Social Medicine, Federal University of Espírito Santo, Vitória, ES, Brazil
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9
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Simon MS, Barton BB, Glocker C, Musil R. A comprehensive approach to predicting weight gain and therapy response in psychopharmacologically treated major depressed patients: A cohort study protocol. PLoS One 2022; 17:e0271793. [PMID: 35862413 PMCID: PMC9302848 DOI: 10.1371/journal.pone.0271793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 07/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background A subgroup of patients with Major Depressive Disorder shows signs of low-grade inflammation and metabolic abberances, while antidepressants can induce weight gain and subsequent metabolic disorders, and lacking antidepressant response is associated with inflammation. Objectives A comprehensive investigation of patient phenotypes and their predictive capability for weight gain and treatment response after psychotropic treatment will be performed. The following factors will be analyzed: inflammatory and metabolic markers, gut microbiome composition, lifestyle indicators (eating behavior, physical activity, chronotype, patient characteristics (childhood adversity among others), and polygenic risk scores. Methods Psychiatric inpatients with at least moderate Major Depressive Disorder will be enrolled in a prospective, observational, naturalistic, monocentric study using stratified sampling. Ethical approval was obtained. Primary outcomes at 4 weeks will be percent weight change and symptom score change on the Montgomery Asberg Depression Rating Scale. Both outcomes will also be binarized into clinically relevant outcomes at 5% weight gain and 50% symptom score reduction. Predictors for weight gain and treatment response will be tested using multiple hierachical regression for continuous outcomes, and multiple binary logistic regression for binarized outcomes. Psychotropic premedication, current medication, eating behavior, baseline BMI, age, and sex will be included as covariates. Further, a comprehensive analysis will be carried out using machine learning. Polygenic risk scores will be added in a second step to estimate the additional variance explained by genetic markers. Sample size calculation yielded a total amount of N = 171 subjects. Discussion Patient and physician expectancies regarding the primary outcomes and non-random sampling may affect internal validity and external validity, respectively. Through the prospective and naturalistic design, results will gain relevance to clinical practice. Examining the predictive value of patient profiles for weight gain and treatment response during pharmacotherapy will allow for targeted adjustments before and concomitantly to the start of treatment.
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Affiliation(s)
- Maria S. Simon
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany
- * E-mail:
| | - Barbara B. Barton
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Catherine Glocker
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University, Munich, Germany
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10
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Diniz BS, Mulsant BH, Reynolds CF, Blumberger DM, Karp JF, Butters MA, Mendes-Silva AP, Vieira EL, Tseng G, Lenze EJ. Association of Molecular Senescence Markers in Late-Life Depression With Clinical Characteristics and Treatment Outcome. JAMA Netw Open 2022; 5:e2219678. [PMID: 35771573 PMCID: PMC9247739 DOI: 10.1001/jamanetworkopen.2022.19678] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE Many older adults with depression do not experience remission with antidepressant treatment, and markers of cellular senescence in late-life depression (LLD) are associated with greater severity of depression, greater executive dysfunction, and higher medical illness burden. Since these clinical characteristics are associated with remission in LLD, molecular and cellular senescence abnormalities could be a possible biological mechanism underlying poor treatment response in this population. OBJECTIVE To examine whether the senescence-associated secretory phenotype (SASP) index was associated with the likelihood of remission from a depressive episode in older adults. DESIGN, SETTING, AND PARTICIPANTS A nonrandomized, open-label clinical trial was conducted between August 2009 and August 2014 in Pittsburgh, Pennsylvania; St Louis, Missouri; and Toronto, Ontario, Canada, with older adults in a current major depressive episode according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) diagnostic criteria. Data from biomarker analyses were reported according to the clinical trial archived plasma samples run in March 2021. Data were analyzed from June to November 2021. EXPOSURE Venlafaxine extended release (dose ranging from 37.5 mg to 300 mg daily) for up to 12 weeks. MAIN OUTCOMES AND MEASURES The association between a composite biomarker-based index (SASP index) and treatment remission in older adults with major depression was measured using clinical data and blood samples. RESULTS There were 416 participants with a mean (SD) age of 60.02 (7.13) years; 64% (265 participants) were self-reported female, and the mean (SD) Montgomery-Asberg Depression Rating Scale score was 26.6 (5.7). Higher SASP index scores were independently associated with higher rates of nonremission, with an increase of 1 unit in the SASP index score increasing the odds of nonremission by 19% (adjusted odds ratio, 1.19; 95% CI, 1.05-1.35; P = .006). In contrast, no individual SASP factors were associated with remission in LLD. CONCLUSIONS AND RELEVANCE Using clinical data and blood samples from a nonrandomized clinical trial, the results of this study suggest that molecular and cellular senescence, as measured with the SASP index, is associated with worse treatment outcomes in LLD. Combining this index score reflecting interrelated biological processes with other molecular, clinical, and neuroimaging markers may be useful in evaluating antidepressant treatment outcomes. These findings inform a path forward for geroscience-guided interventions targeting senescence to improve remission rates in LLD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00892047.
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Affiliation(s)
- Breno S. Diniz
- UConn Center on Aging, University of Connecticut, Farmington
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington
| | - Benoit H. Mulsant
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Charles F. Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Daniel M. Blumberger
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jordan F. Karp
- Department of Psychiatry, The University of Arizona College of Medicine, Tucson
| | - Meryl A. Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ana Paula Mendes-Silva
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Erica L. Vieira
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - George Tseng
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | - Eric J. Lenze
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
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11
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Huang SH, Chen SC, Geng JH, Wu DW, Li CH. Metabolic Syndrome and High-Obesity-Related Indices Are Associated with Poor Cognitive Function in a Large Taiwanese Population Study Older than 60 Years. Nutrients 2022; 14:nu14081535. [PMID: 35458097 PMCID: PMC9026510 DOI: 10.3390/nu14081535] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 12/17/2022] Open
Abstract
Metabolic syndrome (MetS) is prevalent in Taiwan; however, the association between MetS and cognitive function is unclear. The aim of this study was to explore the associations between MetS, its components, and obesity-related indices with cognitive function in a large Taiwanese cohort. We enrolled a total of 28,486 participants who completed the Mini-Mental State Examination (MMSE) questionnaire, which was used to evaluate cognitive function. MetS was defined according to the NCEP-ATP III guidelines and modified criteria for Asians. Ten obesity-related indices were also evaluated: body mass index (BMI), abdominal volume index (AVI), body adiposity index (BAI), waist−hip ratio (WHR), a body shape index (ABSI), lipid accumulation product, waist-to-height ratio (WHtR), conicity index (CI), body roundness index (BRI), and triglyceride glucose index. The prevalence of MetS and its components (except for hypertriglyceridemia) and the number of MetS components increased while the cognitive impairment worsened (from MMSE ≥ 24, 18−23 to 0−17). In addition, increases in all obesity-related index values were associated with a decline in cognitive function (from MMSE ≥ 24, 18−23 to 0−17, ANOVA p < 0.001). Multivariable analysis showed that MetS (p = 0.002), abdominal obesity (p < 0.001), low high-density lipoprotein cholesterol (p = 0.004), and hyperglycemia (p = 0.012) were significantly associated with a low MMSE score. Further, participants with high BMI (p = 0.001), WHR (p < 0.001), WHtR (p < 0.001), BRI (p < 0.001), CI (p < 0.001), BAI (p < 0.001), AVI (p < 0.001), and ABSI (p < 0.001) values were significantly associated with a low MMSE score. Our results show that MetS and its components (except for hypertriglyceridemia and high blood pressure) may lead to cognitive impairment, and that high values of obesity-related indices were associated with poor cognitive function.
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Affiliation(s)
- Szu-Han Huang
- Department of Post Baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Szu-Chia Chen
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (S.-C.C.); (D.-W.W.)
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Jiun-Hung Geng
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan;
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Da-Wei Wu
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (S.-C.C.); (D.-W.W.)
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chien-Hsun Li
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
- Integrated Center of Healthy and Long-Term Care, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
- Correspondence: ; Tel.: +886–7-8036783 (ext. 3453); Fax: +886–7-8063346
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12
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Fahrni ML, Zubir SNAM, Saman KM, Misran NFL, Hassan BAR, Mohammed AH, Wayyes AM. Challenges of prescribing antidepressants for the elderly: a scoping review. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmab064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objectives
With a shift in global demographic trends favouring the older population, depression, which is increasingly common to older adults, is fast becoming a significant public health phenomenon that can result in rising healthcare costs, co-morbidities and fatalities. In particular, challenges to prescribing antidepressants to older people given their altered pharmacodynamic and pharmacokinetic profiles is of major concern to healthcare providers. We aimed to review the challenges encountered by prescribers when diagnosing and selecting older patients suited to receive an antidepressant.
Methods
English articles published between 2011 and 2021 were searched from the three databases which were MEDLINE, Cochrane Library and EMBASE to identify studies related to challenges in prescribing antidepressants for older people with the combination of search keywords such as depression, antidepressants, elderly and challenges, but not limited to them. Studies were excluded if the age of the participant is below 65 years old. The relevancy of the studies to be included were examined initially based on their titles and abstracts. Additional articles were searched from the reference lists of relevant articles.
Key findings
Out of 2500 studies, 11 articles was included in this study. The challenges were classified into three themes: challenges associated with the ageing processes, difficulty in recognising depressive symptoms and challenges in distinguishing depression from cognitive impairment.
Conclusions
Antidepressant prescribing in the elderly is complicated, in which there is a lack of proof for beneficial approaches. The study highlighted pertinent challenges to prescribers when older patients seek drug therapy for depression. This could have easily led to many depression cases gone undiagnosed or misdiagnosed.
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Affiliation(s)
- Mathumalar Loganathan Fahrni
- Faculty of Pharmacy, Universiti Teknologi MARA, Bandar Puncak Alam, Selangor, Malaysia
- Collaborative Drug Discovery Research (CDDR) Group, Communities of Research (Pharmaceutical and Life Sciences), Universiti Teknologi MARA (UiTM), Selangor Darul Ehsan, Malaysia
| | | | - Kamaliah Md Saman
- Faculty of Pharmacy, Universiti Teknologi MARA, Bandar Puncak Alam, Selangor, Malaysia
| | | | | | - Ali Haider Mohammed
- Department of Pharmacy, Al Rafidain University College, Baghdad, Iraq
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
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13
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Chae WR, Fuentes-Casañ M, Gutknecht F, Ljubez A, Gold SM, Wingenfeld K, Otte C. Early-onset late-life depression: Association with body mass index, obesity, and treatment response. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2021; 8:100096. [PMID: 35757669 PMCID: PMC9216262 DOI: 10.1016/j.cpnec.2021.100096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 11/20/2022] Open
Abstract
Early-onset (EOD) and late-onset (LOD) late-life depression might differ in etiology, clinical features, and treatment response. While EOD is more frequently associated with a family history of affective disorders and personality aspects, LOD is thought to be more strongly driven by acquired cerebrovascular risk factors associated with vascular pathology, executive dysfunction, and poor treatment response. However, in a systematic review, EOD and LOD only differed in the frequency of affective disorders in the family history. We compared EOD versus LOD using medical records. In this retrospective chart review, elderly depressed patients (N = 108; mean age: 69.0 ± 7.2 years) were characterized by sociodemographic, psychiatric, and somatic variables and divided according to age-at-onset (cut-off: 60 years): EOD (N = 67, mean age-at-onset: 40.2 ± 13.6 years) and LOD (N = 41, 67.5 ± 6.3 years). A family history of affective disorders was more common in EOD than LOD patients (49.2% vs. 19.5%). EOD patients had a higher body mass index (mean: 27.0 kg/m2 vs. 23.1 kg/m2) and were more often obese compared with LOD patients (20% vs. 0%). There were fewer treatment responders in the EOD group than in the LOD group on trend level significance (46.3% vs. 63.4%). Higher frequency of affective disorders in the family history is compatible with a greater genetic risk of EOD. The larger metabolic burden of EOD might stem from the longer duration of depressive illness. We compared clinical characteristics and treatment response of elderly depressed patients with early-onset vs. late-onset. We found a higher frequency of affective disorders in the family history of early-onset patients. Early-onset patients had a higher body mass index and were more often obese. There were fewer treatment responders in the EOD group than in the LOD group on trend level significance. Our findings point to an increased obesity risk in EOD along with poorer treatment outcome.
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14
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Prolactin and Estrogen Levels in Postmenopausal Women Receiving Aripiprazole Augmentation Treatment for Depression. J Clin Psychopharmacol 2021; 41:31-35. [PMID: 33347020 DOI: 10.1097/jcp.0000000000001335] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Antipsychotic drugs are well established to alter serum prolactin levels, often resulting in adverse effects including amenorrhea, galactorrhea, osteoporosis, and loss of libido. There is growing preclinical evidence that prolactin-elevating drugs can instigate the progression of precancerous lesions to breast cancer and that genes activated by prolactin are associated with the development and proliferation of breast cancer. Current guides advise a cautious approach (weighing risks and benefits) to the administration of prolactin-elevating antipsychotic drugs in women with a previously detected breast cancer. Aripiprazole is known to be a prolactin-sparing antipsychotic; however, data regarding its effects on prolactin and estrogens in postmenopausal women are lacking. METHODS We examined serum hormone levels in n = 66 women who participated in a randomized, double-blind, placebo-controlled, multicenter trial of aripiprazole (high and low doses) added to an antidepressant in adults older than 60 years. Aripiprazole or placebo tablets were administered for 12 weeks as an augmentation strategy in venlafaxine-treated women. The primary outcomes were the difference in prolactin and estrogen levels. RESULTS There was no significant effect of aripiprazole treatment on prolactin or estrogen levels, including in models that divided groups into low and high doses: prolactin (P = 0.075), estrone (P = 0.67), and estradiol (P = 0.96). CONCLUSIONS Aripiprazole addition to an antidepressant did not alter serum estrogens or prolactin. These findings may be relevant in the treatment of some postmenopausal women with depression.
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15
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Hough CM, Bersani FS, Mellon SH, Morford AE, Lindqvist D, Reus VI, Epel ES, Wolkowitz OM. Pre-treatment allostatic load and metabolic dysregulation predict SSRI response in major depressive disorder: a preliminary report. Psychol Med 2021; 51:2117-2125. [PMID: 32438932 DOI: 10.1017/s0033291720000896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is associated with increased allostatic load (AL; a measure of physiological costs of repeated/chronic stress-responding) and metabolic dysregulation (MetD; a measure of metabolic health and precursor to many medical illnesses). Though AL and MetD are associated with poor somatic health outcomes, little is known regarding their relationship with antidepressant-treatment outcomes. METHODS We determined pre-treatment AL and MetD in 67 healthy controls and 34 unmedicated, medically healthy MDD subjects. Following this, MDD subjects completed 8-weeks of open-label selective serotonin reuptake inhibitor (SSRI) antidepressant treatment and were categorized as 'Responders' (⩾50% improvement in depression severity ratings) or 'Non-responders' (<50% improvement). Logistic and linear regressions were performed to determine if pre-treatment AL or MetD scores predicted SSRI-response. Secondary analyses examined cross-sectional differences between MDD and control groups. RESULTS Pre-treatment AL and MetD scores significantly predicted continuous antidepressant response (i.e. absolute decreases in depression severity ratings) (p = 0.012 and 0.014, respectively), as well as post-treatment status as a Responder or Non-responder (p = 0.022 and 0.040, respectively), such that higher pre-treatment AL and MetD were associated with poorer SSRI-treatment outcomes. Pre-treatment AL and MetD of Responders were similar to Controls, while those of Non-responders were significantly higher than both Responders (p = 0.025 and 0.033, respectively) and Controls (p = 0.039 and 0.001, respectively). CONCLUSIONS These preliminary findings suggest that indices of metabolic and hypothalamic-pituitary-adrenal-axis dysregulation are associated with poorer SSRI-treatment response. To our knowledge, this is the first study to demonstrate that these markers of medical disease risk also predict poorer antidepressant outcomes.
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Affiliation(s)
- Christina M Hough
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - F Saverio Bersani
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Synthia H Mellon
- Department of OB/GYN and Reproductive Sciences, UCSF School of Medicine, San Francisco, CA, USA
| | - Alexandra E Morford
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel Lindqvist
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
- Department of Clinical Sciences, Section for Psychiatry, Lund University, Lund, Sweden
| | - Victor I Reus
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Elissa S Epel
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Owen M Wolkowitz
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
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16
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Schneider C, Breilmann J, Reuter B, Becker T, Kösters M. Systematic evaluation of the 'efficacy-effectiveness gap' in the treatment of depression with venlafaxine and duloxetine. Acta Psychiatr Scand 2021; 144:113-124. [PMID: 33661520 DOI: 10.1111/acps.13293] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Evidence of larger drug effects in highly standardized studies (efficacy) compared to clinical routine (effectiveness) is discussed as efficacy-effectiveness gap. This study aimed to quantify effect size differences of RCTs and non-RCTs in the treatment of depression with venlafaxine and duloxetine and to identify effect modifying predictors. METHODS A comprehensive systematic review and meta-analysis was conducted, including all prospective trials, which evaluated the treatment effects of duloxetine or venlafaxine in patients with depression. The primary outcome was the pre-post effect size after acute therapy, which were compared between RCTs and non-RCTs. Moreover, an exploratory analysis of predictors in a mixed meta-regression model within an information-theoretic approach was performed. RESULTS 171 RCTs and 74 non-RCTs were included. The pre-post effect size differed significantly between RCTs and non-RCTs (-3.04 vs. -2.62, Δ = 0.41, p = 0.012, high heterogeneity). Study characteristics were very similar between RCTs and non-RCTs. Most important variables to predict effect sizes were 'depression severity', 'dose' and 'number of participants'. CONCLUSION Despite differences in effect sizes between RCTs and non-RCTs, study design is not clearly an important predictor for the effect sizes. Our results question the common assumption that non-RCTs are generally better suited to describe a drug's effectiveness in clinical practice than RCTs. Future studies and their reporting should put more emphasis on the description of external validity, in order to allow better assessments of clinical relevance.
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Affiliation(s)
- Carolin Schneider
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Germany.,Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johanna Breilmann
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Germany
| | - Benedikt Reuter
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Becker
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Germany
| | - Markus Kösters
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Germany
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17
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Piras F, Banaj N, Porcari DE, Piras F, Spalletta G. Later life depression as risk factor for developing dementia: epidemiological evidence, predictive models, preventive strategies and future trends. Minerva Med 2021; 112:456-466. [PMID: 34056888 DOI: 10.23736/s0026-4806.21.07571-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Current investigations in pre-symptomatic dementia have suggested that depressive mood, a treatable condition, may play an important role in the development of the disorder. However, whether depression in adulthood constitute a risk factor, or a prodrome of dementia remains unclear. A major implication in such dispute is the analytic framework used to identify putative risk factors. Indeed, if evaluated in the years immediately prior to dementia diagnosis the association between depression and dementia may reflect depressive symptoms as a prodrome of yet-undiagnosed dementia. Unfortunately, long term prospective cohort investigations, reaching back into the preclinical phase of dementia are sparse. Here, we have surveyed high-quality evidence (systematic reviews and meta-analyses) on the association between depressive symptoms and increased odds of dementia. Meta-analytic findings are also presented and discussed regarding depression as a prodromal stage of dementia, or a consequence of underlying neurodegenerative processes. Additionally, the potential confounding effect of several variables on the risk association between depression and dementia, an aspect hardly investigated, is discussed. While early onset late-life depression - defined as starting before 60 years of age - increases the odds of developing dementia in predisposed subjects, late-onset depression appears to be a prodrome and a clear accelerating factor for cognitive deterioration. Since it is increasingly important to consider the potential of preemptive approaches to decrease the impact of dementia, evidence on potentially effective preventive strategies targeting depression as a risk factor, and next steps in further research are presented as concluding remarks.
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Affiliation(s)
- Federica Piras
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Nerisa Banaj
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Desirée E Porcari
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Fabrizio Piras
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Gianfranco Spalletta
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy - .,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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18
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Ferri F, Deschênes SS, Power N, Schmitz N. Associations between cognitive function, metabolic factors and depression: A prospective study in Quebec, Canada. J Affect Disord 2021; 283:77-83. [PMID: 33524662 DOI: 10.1016/j.jad.2021.01.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/09/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Metabolic risk factors, low cognitive function and history of depression are known risk factors for future depressive episodes. This paper aims to evaluate the potential interactions between these factors on the risk of a major depressive episodes in middle-age. METHODS Baseline and follow-up data from a population-based study of Quebec, Canada were used. The sample consisted of 1788 adults between 40 and 69 years of age without diabetes. Cognitive function and metabolic risk factors were assessed at baseline. Three cognitive domains were assessed: processing speed, episodic memory and executive function. History of depression was assessed five years later by a clinical interview. Logistic regression analysis was conducted to evaluate interactions between individual metabolic factors, low cognitive function, and depression history. RESULTS Participants with a comorbidity of at least one metabolic factor, history of depression and low cognitive function had the highest risk of experiencing a depressive episode in middle age. The highest risk was observed in individuals with abdominal obesity, low cognitive function, and a history of depression (OR= 8.66, 95% CI 3.83-19.59). The risks for those with abdominal obesity only, depression history only, and low cognitive function were 1.20 (95%CI 0.71-2.02), 3.10 (95%CI 1.81-5.24), and 1.39 (95%CI 0.72-2.67), respectively. LIMITATIONS Depression was only assessed at follow-up. CONCLUSION Metabolic risk factors comorbid with low cognitive function in middle-aged individuals with a history of depression were associated with an increased risk of a future depressive episode. This study highlights the importance of screening for metabolic and cognitive comorbidities in patients with a history of depression.
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Affiliation(s)
- Floriana Ferri
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada; Douglas University Mental Health Institute, Montreal, QC, Canada
| | - Sonya S Deschênes
- Douglas University Mental Health Institute, Montreal, QC, Canada; School of Psychology, University College Dublin, Dublin, Ireland
| | - Niamh Power
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada; Douglas University Mental Health Institute, Montreal, QC, Canada
| | - Norbert Schmitz
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada; Douglas University Mental Health Institute, Montreal, QC, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada; Montreal Diabetes Research Centre, Montreal, QC, Canada.
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19
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The prevalence and related factors of metabolic syndrome in outpatients with first-episode drug-naive major depression comorbid with anxiety. Sci Rep 2021; 11:3324. [PMID: 33558554 PMCID: PMC7870819 DOI: 10.1038/s41598-021-81653-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/06/2021] [Indexed: 01/13/2023] Open
Abstract
Metabolic syndrome (MetS) is associated with depression, but its role in major depressive disorder comorbid with anxiety (AMD) is unclear. This study aimed to investigate the prevalence and clinical correlates of MetS in first-episode drug-naive (FEDN) patients with AMD in a Chinese Han population. In total, 1380 FEDN outpatients with AMD were recruited in this cross-sectional study. The sociodemographic features, clinical characteristics, history of suicide attempts, thyroid-stimulating hormone (TSH) levels, and MetS parameters of each subject were evaluated. All subjects were rated on the Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and the Positive and Negative Syndrome Scale positive symptom subscale. The prevalence of MetS among AMD patients was 8.04%. Compared to the non-MetS group, age, age of onset, TSH level, HAM-A and HAM-D scores, history of attempted suicide, and comorbid psychiatric symptoms were higher in the MetS group. Those in this group were also more likely to be married, and they had a lower educational level. Furthermore, age, psychiatric symptoms, suicide attempts, and higher TSH levels were independently associated with MetS in AMD patients. This study suggests a lower prevalence of MetS in FEDN patients with AMD in a Chinese Han population. Older age, comorbid psychiatric symptoms, history of attempted suicide, and higher TSH levels are related factors for MetS in AMD patients.
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Voelker J, Joshi K, Daly E, Papademetriou E, Rotter D, Sheehan JJ, Kuvadia H, Liu X, Dasgupta A, Potluri R. How well do clinical and demographic characteristics predict Patient Health Questionnaire-9 scores among patients with treatment-resistant major depressive disorder in a real-world setting? Brain Behav 2021; 11:e02000. [PMID: 33403828 PMCID: PMC7882175 DOI: 10.1002/brb3.2000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/06/2020] [Accepted: 11/18/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To create and validate a model to predict depression symptom severity among patients with treatment-resistant depression (TRD) using commonly recorded variables within medical claims databases. METHODS Adults with TRD (here defined as > 2 antidepressant treatments in an episode, suggestive of nonresponse) and ≥ 1 Patient Health Questionnaire (PHQ)-9 record on or after the index TRD date were identified (2013-2018) in Decision Resource Group's Real World Data Repository, which links an electronic health record database to a medical claims database. A total of 116 clinical/demographic variables were utilized as predictors of the study outcome of depression symptom severity, which was measured by PHQ-9 total score category (score: 0-9 = none to mild, 10-14 = moderate, 15-27 = moderately severe to severe). A random forest approach was applied to develop and validate the predictive model. RESULTS Among 5,356 PHQ-9 scores in the study population, the mean (standard deviation) PHQ-9 score was 10.1 (7.2). The model yielded an accuracy of 62.7%. For each predicted depression symptom severity category, the mean observed scores (8.0, 12.2, and 16.2) fell within the appropriate range. CONCLUSIONS While there is room for improvement in its accuracy, the use of a machine learning tool that predicts depression symptom severity of patients with TRD can potentially have wide population-level applications. Healthcare systems and payers can build upon this groundwork and use the variables identified and the predictive modeling approach to create an algorithm specific to their population.
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Affiliation(s)
| | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Ella Daly
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | | | | | | | | | - Xing Liu
- SmartAnalyst, Inc, New York, NY, USA
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21
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Grover S, Chakravarty R, Mehra A, Chakrabarti S. Prevalence of metabolic syndrome in elderly patients with depression. JOURNAL OF GERIATRIC MENTAL HEALTH 2021. [DOI: 10.4103/jgmh.jgmh_8_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Yang QQ, Shao D, Li J, Yang CL, Fan MH, Cao FL. Positive Association Between Serum Levels of High-Sensitivity C-Reactive Protein and Depression/Anxiety in Female, but Not Male, Patients With Type 2 Diabetes Mellitus. Biol Res Nurs 2019; 22:178-187. [PMID: 31867989 DOI: 10.1177/1099800419894641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose: Patients with Type 2 diabetes (T2D) have increased risk of depression and anxiety. Evidence suggests that a heightened inflammatory state may contribute to this association. Females experience more depression and higher inflammation levels than males. This study compared associations of serum high-sensitivity C-reactive protein (hs-CRP) levels with symptoms of depression and anxiety between men and women with Type 2 diabetes mellitus (T2DM). Method: Cross-sectional data including demographic and disease characteristics, symptoms of depression and anxiety, clinical data, and laboratory values were collected from 392 patients with T2DM recruited from a general hospital in Shandong Province, China. We evaluated associations between serum hs-CRP level and symptoms of depression and anxiety in males and females separately using multiple linear regressions and χ2 tests for trend. Results: Sex moderated the association between serum hs-CRP level and symptoms of depression ( B = .112 [ SE = 0.049]; p = .022) and anxiety ( B = .137 [ SE = 0.053]; p = .011). Among females, hs-CRP level was positively associated with depression ( B = .034, 95% confidence interval [CI] = [.006, .061]; p = .016, false discovery rate [FDR]-adjusted p = .020) and anxiety ( B = .041, 95% CI [.011, .071], p = .007, FDR-adjusted p = .007). Positive trends indicated a higher prevalence of clinically significant symptoms of depression and anxiety in higher serum hs-CRP categories in females. No associations were found in males. Conclusion: Findings demonstrate that associations between serum hs-CRP level and symptoms of depression and anxiety in patients with T2D are sex-specific, with only females demonstrating a significant positive association.
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Affiliation(s)
- Qian-Qian Yang
- School of Nursing, Shandong University, Shandong, People’s Republic of China
| | - Di Shao
- School of Health Care Management, Shandong University, Shandong, People’s Republic of China
| | - Jie Li
- School of Public Health, Shandong University, Shandong, People’s Republic of China
| | - Chun-Ling Yang
- Nursing Department, Liaocheng People’s Hospital, Shandong, People's Republic of China
| | - Min-Hua Fan
- Endocrinology Department, Liaocheng People’s Hospital, Shandong, People's Republic of China
| | - Feng-Lin Cao
- School of Nursing, Shandong University, Shandong, People’s Republic of China
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23
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Dekker IP, Marijnissen RM, Giltay EJ, van der Mast RC, Oude Voshaar RC, Rhebergen D, Rius Ottenheim N. The role of metabolic syndrome in late-life depression over 6 years: The NESDO study. J Affect Disord 2019; 257:735-740. [PMID: 31386966 DOI: 10.1016/j.jad.2019.07.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/29/2019] [Accepted: 07/04/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Metabolic syndrome (MetS) has been associated with both early- and late-life depression. This study investigated whether baseline MetS and its individual components are associated with the course of depression over six years among older persons with a formal depression diagnosis. METHODS Data were used from 378 older persons with a depressive disorder from the Netherlands Study of Depression in Old age (NESDO) with a 6-year follow-up. A formal depression diagnosis according to DSM-IV-TR criteria was ascertained with the Composite International Diagnostic Interview. Severity of depressive symptoms was assessed with the Inventory of Depressive Symptomatology at 6-month intervals. Metabolic syndrome (MetS) was defined according the modified National Cholesterol Education Programme - Adult Treatment Panel III criteria. Primary outcome was time to remission from depression. We applied cox regression analysis for the primary outcome and linear mixed models for secondary analyses. RESULTS Neither MetS nor its individual components were associated with time to remission from depression (MetS: HR = 1.03; 95% CI = 0.74 - 1.44; p = 0.85), or with depression severity (MetS: B = 0.02; SE = 0.04; p = 0.64) and course of depressive symptoms (MetS: B = -0.01; SE = 0.01; p = 0.23) over 6-years follow-up. LIMITATIONS Attrition was relatively high (46.8%). Furthermore, we only had information on formal depression diagnosis at baseline, 2-year, and 6-year follow-up. CONCLUSIONS We found no evidence for an effect of baseline presence of metabolic dysregulation on the course of formally diagnosed depression in older persons. Metabolic syndrome in depressed patients should be clinically monitored for other reasons than predicting chronicity or severity of depression.
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Affiliation(s)
- Ilse P Dekker
- Department of Psychiatry, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, the Netherlands.
| | - Radboud M Marijnissen
- Department of Psychiatry & Interdisciplinary Center for Psychopathology of Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, the Netherlands; Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Roos C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, the Netherlands; Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Richard C Oude Voshaar
- Department of Psychiatry & Interdisciplinary Center for Psychopathology of Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Didi Rhebergen
- GGZ inGeest/Department of Psychiatry and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Nathaly Rius Ottenheim
- Department of Psychiatry, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, the Netherlands.
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Sex-specific roles of cellular inflammation and cardiometabolism in obesity-associated depressive symptomatology. Int J Obes (Lond) 2019; 43:2045-2056. [PMID: 31089263 PMCID: PMC6774832 DOI: 10.1038/s41366-019-0375-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 02/06/2019] [Accepted: 03/29/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Obesity and depression are complex conditions with stronger comorbid relationships among women than men. Inflammation and cardiometabolic dysfunction are likely mechanistic candidates for increased depression risk, and their prevalence differs by sex. Whether these relationships extend to depressive symptoms is poorly understood. Therefore, we analyzed sex in associations between inflammation and metabolic syndrome (MetS) criteria on depressive symptomatology. Specifically, we examined whether sex positively moderates the relationship between depressive symptoms and inflammation among women, and whether MetS has parallel effects among men. METHODS Depressive symptoms, MetS, and inflammation were assessed in 129 otherwise healthy adults. Depressive symptoms were assessed using Beck Depression Inventory (BDI-Ia). Monocyte inflammation regulation (BARIC) was quantified using flow cytometry measurement of TNF-α suppression by β-agonist. Moderation effects of sex on associations between BARIC, MetS criteria, and BDI were estimated using two-way ANOVA and linear regression, adjusting for BMI, and by sex subgroup analyses. RESULTS Obese individuals reported more depressive symptoms. Sex did not formally moderate this relationship, though BDI scores tended to differ by BMI among women, but not men, in subgroup analysis. Poorer inflammation control and higher MetS criteria were correlated with somatic depressive symptoms. Sex moderated associations between MetS criteria and somatic symptoms; among men, MetS criteria predicted somatic symptoms, not among women. Subgroup analysis further indicated that poorer inflammation control tended to be associated with higher somatic symptoms in women. CONCLUSIONS These results indicate that obesity-related inflammation and MetS factors have sex-specific effects on depressive symptoms in a non-clinical population. Although pathophysiological mechanisms underlying sex differences remain to be elucidated, our findings suggest that distinct vulnerabilities to depressive symptoms exist between women and men, and highlight the need to consider sex as a key biological variable in obesity-depression relationships. Future clinical studies on comorbid obesity and depression should account for sex, which may optimize therapeutic strategies.
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25
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Agustini B, Mohebbi M, Woods RL, McNeil JJ, Nelson MR, Shah RC, Murray AM, Ernst ME, Reid CM, Tonkin A, Lockery JE, Berk M. Association Between Statin Use and Depressive Symptoms in a Large Community-Dwelling Older Population Living in Australia and the USA: A Cross-Sectional Study. CNS Drugs 2019; 33:685-694. [PMID: 31062260 PMCID: PMC6719539 DOI: 10.1007/s40263-019-00633-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Statin use has been frequently associated with depressive symptoms in an older population. However, the nature of this association is uncertain in the literature. In this study, we aimed to investigate the association of statin intake and the prevalence of depressive symptoms in healthy community-dwelling older adults living in Australia and the USA. METHODS We analysed baseline data from 19,114 participants, over 70 years of age (over 65 years of age, if from an ethnic minority). The association of self-reported statin use and prevalence of depressive symptoms, as measured by a validated depression scale [Center for Epidemiological Studies Depression Scale (CES-D 10)], was determined using logistic regression models. Multivariable logistic models were implemented to account for important demographics and other lifestyle and socioeconomic factors, such as sex, age, living status, education and smoking history. RESULTS A total of 5987 individuals were statin users. Of those, 633 (10.6%) had depressive symptoms (CES-D 10 cut-off ≥ 8), compared with 1246 (9.5%) of the non-statin users. In the unadjusted model, statin use was associated with an increase in prevalence of depressive symptoms (odds ratio 1.13, confidence interval 1.02-1.25, p = 0.02). However, after adjusting for important demographic and socioeconomic factors, the use of statins was not significantly associated with depressive symptoms (odds ratio 1.09, confidence interval 0.98-1.20, p = 0.11). In secondary analyses, only simvastatin was marginally associated with an increased prevalence of depressive symptoms. Statins were associated with a decreased prevalence of depressive symptoms in individuals with severe obesity (body mass index > 35 kg/m2) and an increased prevalence in participants between 75 and 84 years of age. CONCLUSION This study in a large community-dwelling older population did not show any association of statins with late-life depressive symptoms, after accounting for important socioeconomic and demographic factors. Confounding by indication is an important issue to be addressed in future pharmacoepidemiologic studies of statins.
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Affiliation(s)
- Bruno Agustini
- IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre), School of Medicine, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.
| | - Mohammadreza Mohebbi
- IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre), School of Medicine, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia
- Biostatistics Unit, Deakin University, Geelong, VIC, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Hennepin Healthcare, Minneapolis, MN, USA
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa, IO, USA
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa, IO, USA
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Andrew Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jessica E Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael Berk
- IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre), School of Medicine, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia
- Orygen, National Centre of Excellence in Youth Health, Department of Psychiatry and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
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26
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Matić TB, Toncev G, Gavrilović A, Aleksić D. Suffering from Cerebral Small Vessel Disease with and without Metabolic Syndrome. Open Med (Wars) 2019; 14:479-484. [PMID: 31231684 PMCID: PMC6572407 DOI: 10.1515/med-2019-0051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/01/2019] [Indexed: 12/24/2022] Open
Abstract
Background Cerebral small vessel disease (CSVD) and metabolic syndrome were separately associated with cognitive impairment and depression. However, whether metabolic syndrome adds to cognitive impairment and depression in patients who already have CSVD remained unanswered. Objective The aim of our study was to investigate the association of metabolic syndrome with cognitive impairment and depression in patients with CSVD who have lacunar lesions or white matter hyperintensities. Methods This prospective cohort study was conducted at Neurology Clinic, Clinical Center, Kragujevac, Serbia. Main outcomes of the study were cognitive assessment, and assessment of depression among hospitalized patients with or without CSVD. Results The study included 74 inpatients, 25 of them having lacunary infarctions, 24 with the white matter hyperintensities, and 25 control patients without CSVD. The CSVD was accompanied by impairment of cognition and depression, the patients with lacunary lesions being more cognitively impaired and more depressive than the patients with the white matter hyperintensities. The patients with CSVD who also had metabolic syndrome were more cognitively impaired and depressed than the patients with CSVD alone. Conclusions In conclusion, our study showed that metabolic syndrome is associated with further worsening of already impaired cognition and existing depression in patients with CSVD.
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Affiliation(s)
- Tatjana Bošković Matić
- Clinical Center Kragujevac, Clinic of neurology, Zmaj Jovina 30, 34000 Kragujevac, Serbia
| | - Gordana Toncev
- University of Kragujevac, Faculty of Medical Sciences, and Clinical Center, Kragujevac, Serbia
| | - Aleksandar Gavrilović
- University of Kragujevac, Faculty of Medical Sciences, and Clinical Center, Kragujevac, Serbia
| | - Dejan Aleksić
- University of Kragujevac, Faculty of Medical Sciences, and Clinical Center, Kragujevac, Serbia
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27
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de Wit AE, Giltay EJ, de Boer MK, Bosker FJ, van der Mast RC, Comijs HC, Oude Voshaar RC, Schoevers RA. Associations between testosterone and metabolic syndrome in depressed and non-depressed older men and women. Int J Geriatr Psychiatry 2019; 34:463-471. [PMID: 30474223 PMCID: PMC6590367 DOI: 10.1002/gps.5040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 11/14/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Older age and major depressive disorder (MDD) are both risk factors for the development of cardiovascular diseases. Testosterone has been associated with MDD and metabolic syndrome (MetS) in men, although associations in women are less clear. Therefore, we investigated whether testosterone is associated with MetS and whether this association is different for depressed and non-depressed older men and women. METHODS In this prospective cohort study, 478 participants (349 patients with MDD and 129 controls) aged between 60 and 93 years from the Netherlands Study of Depression in Older Persons were included. Total testosterone (TT) and sex-hormone binding globulin levels were measured using a second-generation radioimmune assay. Free testosterone (FT) was calculated based on TT. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS A higher risk for MetS was found in men with low FT and TT (odds ratio [OR]: 0.67, 95% confidence interval [95%CI]: 0.47-0.95 and OR: 0.51, 95%CI: 0.34-0.75), and in women with high FT (OR: 1.41, 95%CI: 1.08-1.82). Strong associations in the same direction were found with adiposity, glucose, and plasma lipid MetS components at baseline, but not with changes in these components at 2-year follow-up. The associations did not significantly differ between MDD patients and controls. CONCLUSIONS Independently of having MDD, low testosterone levels in men and, in contrast, high testosterone levels in women were significantly associated with MetS and its components.
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Affiliation(s)
- Anouk E. de Wit
- Department of PsychiatryUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Erik J. Giltay
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
| | - Marrit K. de Boer
- Department of PsychiatryUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Fokko J. Bosker
- Department of PsychiatryUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Roos C. van der Mast
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
- Department of PsychiatryCAPRI‐University of AntwerpBelgium
| | - Hannie C. Comijs
- GGZinGeest/Department of PsychiatryVU University Medical Center, Amsterdam Public Health research instituteAmsterdamThe Netherlands
| | - Richard C. Oude Voshaar
- Department of PsychiatryUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Robert A. Schoevers
- Department of PsychiatryUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
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Chedraui P, Pérez-López FR. Metabolic syndrome during female midlife: what are the risks? Climacteric 2019; 22:127-132. [DOI: 10.1080/13697137.2018.1561666] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- P. Chedraui
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - F. R. Pérez-López
- Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine and Lozano-Blesa University Hospital, Zaragoza, Spain
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Dey A, Hankey Giblin PA. Insights into Macrophage Heterogeneity and Cytokine-Induced Neuroinflammation in Major Depressive Disorder. Pharmaceuticals (Basel) 2018; 11:E64. [PMID: 29941796 PMCID: PMC6160985 DOI: 10.3390/ph11030064] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 12/13/2022] Open
Abstract
Over 350 million individuals suffer from depression, a psychiatric illness classified as major depressive disorder (MDD) with symptoms that include a loss of interest or pleasure in life accompanied by depressed mood. The present understanding of major depressive disorder does not encompass a systematic characterization of the neurobiological processes that drive the behavioral physiology in patients diagnosed with major depressive disorder. Psychiatric illness is a complex intersection between genetics, physiology, immunology and environmental stress. The increased attention to the relevance of depression has led to new discoveries that highlight the biological significance of ‘neuroinflammation’ and immunity underlying a spectrum of psychiatric illnesses. The process of neuroinflammation involves sentinel immune cells in the central nervous system (CNS). The activation and polarization of microglia, CNS-resident macrophages, modulates the production and secretion of pro-inflammatory cytokines implicated in the etiology of major depressive disorder, and this phenomenon has been aptly titled the ‘macrophage theory of depression’. Of particular interest are three hallmark cytokines, IL-6, TNFα and IL-1β, which have been studied extensively in basic research, cell-receptor signaling and drug development. The field of inflammasome-mediated neuroinflammation is an emerging area of MDD research that is providing new cellular insight into how macrophages mechanistically support cytokine-associated neuropathology, particularly in the case of IL-1β-associated inflammation in MDD. With the increasing number of individuals identified with depression, a comprehensive understanding of macrophage-cytokine signaling pathways in the CNS in depression is necessary for developing effective anti-depressant therapeutics.
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Affiliation(s)
- Adwitia Dey
- Center for Molecular Immunology and Infectious Diseases, The Pennsylvania State University, University Park, State College, PA 16802, USA.
- Department of Veterinary and Biomedical Sciences, The Pennsylvania State University, University Park, State College, PA 16802, USA.
| | - Pamela A Hankey Giblin
- Center for Molecular Immunology and Infectious Diseases, The Pennsylvania State University, University Park, State College, PA 16802, USA.
- Department of Veterinary and Biomedical Sciences, The Pennsylvania State University, University Park, State College, PA 16802, USA.
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